Starting in 2014, The Affordable Care Act requires health-insurance plans, both individual and small-group coverage, to provide essential benefits in at least ten categories. In order to be certified and offered through healthplanfinder, all policies must cover services in the following categories:
Ambulatory care. This coverage applies to advanced medical treatments, generally in a hospital setting, that are performed on an outpatient basis. These services include diagnostic procedures such as x-rays, blood tests, MRI’s and biopsies, as well as minor surgeries in which the patient registers and is discharged within the same calendar day.
Emergency services. As the term states, these services apply to response and treatment of acute conditions that require immediate care. Coverage includes on-site stabilization care, ambulance services and emergency-room treatment.
Hospitalization. In-patient coverage kicks in when a hospital stay extends beyond a calendar day. Hospitalization is far and away the most expensive setting of care delivery. Plans can vary widely in coverage levels. The best policy options depend heavily upon life stage and any existing conditions.
Maternity and newborn care. This coverage applies to minimum length of hospital care for mother and newborn(s). The requirements specified in the Newborns’ & Mothers’ Health Protection Act of 1996 will be required of all individual and small-group plans. Natural childbirth stays can be limited to no less than 48 hours and cesarean deliveries to no less than 96 hours; though discharge can be earlier if patient and doctor agree.
Mental-health and substance-abuse treatment. Starting 2014, an estimated 32 million Americans will gain access to these vital “whole-person” services. Coverage for identified behavioral disorders and substance abuse will be treated the same way as coverage for medical disorders. These services include one-on-one sessions as well as group and community treatment settings.
Prescription drugs. Most plans currently include options for medication co-pays. All policies to take effect in 2014 will have to include provisions for coverage of prescription drugs. For those on multiple prescriptions, especially seniors, this coverage can be particularly crucial.
Rehabilitative and habilitative services and devices. Rehabilitative services are those that help patients to regain full or partial functioning and improve daily living skills lost or impaired due to injury or illness. Habilitative services refer to those that help patients, particularly children, learn and improve daily living skills, such as a child experiencing difficulty walking or talking at the expected age. Services for both rehabilitative and habilitative care include physical and occupational therapy, speech-language pathology and psychiatric rehabilitative services in both inpatient and outpatient settings. Devices may include braces, walkers and prosthetic limbs.
Laboratory services. Lab services are typically covered under current policies, and must be covered under the new act. These services relate to analysis of bodily fluids, particularly blood and biopsy tissue for disease and other factors.
Wellness and chronic disease management. The easiest conditions to treat are those that never occur. In 2014 all policies must cover services aimed at preventative and chronic care including health screenings, check-ups, monitoring devices and patient education.
Pediatric services, including oral and vision care. Starting in 2014, policies sold through an exchange must include provisions for coverage of healthcare of dependents, including dental and vision care.
For more information on the Affordable Care Act and how it will affect you and your family, contact us at Washington Health Insurance Exchange at 360-464-1622.
A Health Insurance Exchange is designed to make buying health coverage
easier and more affordable.
Use this website to see if you’re eligible for tax credits for private
insurance or health programs like the Children’s Health Insurance Program
(CHIP) and Apple Health. Input your household income, county you live in,
and your age. Then simply press the green ‘go’ button.
The calculator will determine if you qualify for new federal financial
assistance that you can use right away to reduce the cost of monthly payments
and out-of-pocket expenses. You’ll be able to compare health plans, their
benefits and premiums, side-by-side.
If you do not qualify for financial assistance, we will be able to compare your options from top-rated private health carriers in the direct market. All new health plans in Washington cover pre-existing medical conditions and no one can be turned down for coverage.
Have questions or need help enrolling? Just call 360-464-1622 and a licensed health insurance professional will answer all of your questions, help you
choose the right health plan to meet your needs, and walk you through the
enrollment process step by step.
Washington Health Insurance Exchange is an approved division of the Washington Health Insurance Agency, featuring top performing producers on Washington’s Healthplanfinder and licensed by the Office of Insurance Commissioner.
Washington Health Insurance Exchange is also an approved agency for each
of the major private health insurance carriers in Washington including
Regence Blue Shield, Premera Blue Cross, Moda Health, LifeWise Health plans
of WA, Assurant Health, Kaiser, Group Health Cooperative and Group Health
Disclosure: The Washington Health Insurance Exchange website is designed to help Washington residents determine if they qualify for lower health premiums through the Washington Healthplanfinder and enroll in a qualified health plan with the assistance of a licensed broker in the state of Washington. Only independent licensed agents/brokers who are registered producers for Washington’s HealthPlanFinder are authorized to give advice and make recommendations regarding health plans in the healthplanfinder. Washington Health Insurance Exchange is a division of the Washington Health Insurance Agency whose agent/owner is a registered producer for wahealthplanfinder.org and a licensed producer in the state of Washington. Our staff and licensed agents are not government employees, employees of the state, or the Washington Health Plan Finder. We make no claim or claims to represent, constitute, and/or otherwise provide other services on behalf of the Washington HealthPlanFinder. Any and all suggestions, claims, and/or implications to the contrary are hereby denied.
Ten essential health benefits
Starting in 2014, The Affordable Care Act requires health-insurance plans,
both individual and small-group coverage, to provide essential benefits in at
least ten categories. In order to be certified and offered through
healthplanfinder, all policies must cover services in the following
Read More »
How affordable will the Affordable Care Act be?
The Affordable Care Act, which took affect in 2014, can potentially
entail higher premiums; but it also offers offsetting savings as well. All
health policies will have to cover [10 essential benefits], such as
prescription drugs and rehabilitative care. More robust coverage typically
entails higher costs. Thus, typical premiums for individual and small-group
plans may indeed rise. However, tax credits, subsidized plans and reduced
premiums may make yearly healthcare costs approximately equal or even lower
for those that meet income criteria.
Read More »
What is the premium tax credit?
The premium tax credit is an advanceable, refundable tax credit designed
to help eligible individuals and families with low or moderate income afford
health insurance purchased through the healthplanfinder, beginning
in 2014. You can choose to have the credit paid in advance to your insurance
company to lower what you pay for your monthly premiums, or you can claim all
of the credit when you file your tax return for the year. If you choose to
have the credit paid in advance, you will reconcile the amount paid in
advance with the actual credit you compute when you file your tax return.
Read More »
FAQ – Updated for 2017
When will I be required to get health insurance?
The Affordable Care Act went into effect on January 1, 2014, requiring US Citizens and those lawfully present to obtain Minimal Essential Coverage. Enrollment in any of the plans presented on this site and carried for 10-out–12 months will satisfy the mandate. Other means include Medicare, Employer Sponsored Coverage, Tri-Care, COBRA, Medicaid. For exemptions, we recommend visiting HealthCare.Gov.
What is the penalty if I remain uninsured?
Those who remain uninsured in 2016 will be subject to a minimum penalty of $695/adult and $347.50/child OR 2.5 percent of household income, with a maximum penalty of $2,085. For 2017 and beyond the rate will remain constant at 2.5%, but the flat fee will adjust based on inflation.
Why should I visit Washington Health Insurance Exchange?
We’ve created this website for our clients to quickly and easily shop and compare all their options, side-by-side. Multiple providers compete for your business. You can search for plans according to price, coverage options and that include your current doctor. Depending on income level, you may qualify for free coverage or lower premiums and co-pays.
Why do my premiums keep going up?
Carriers have suffered incredible losses over the past few years since the ACA went live, especially those offering PPO plans (plans allowing you to pick and choose your provider with nation-wide networks). Many carriers have exited the market altogether – Moda, United Health and Assurant have all pulled out of Washington over the past few years. Aetna, (one of Nation’s largest health insurance companies) has also pulled their plans from markets nationwide. In Washington State, if you pull a product line from the market, you can’t re-enter for 5 years. So, this is not a decision that the carriers take lightly. Carriers are left with raising the premiums and negotiating tougher contracts with Providers in order to account for the rising cost of health care and account for past/projected losses.
Will I still be able to see my current physician?
This is becoming more and more difficult as Health Insurers are moving to much narrower networks in order to control costs, improve care and better coordinate your experience navigating health care delivery systems. Our site enables you to sort plans by provider; so you can choose a plan that includes access to your doctor.
Limited Networks – What are Accountable Health Networks?
Several carriers in populous areas in Washington State are moving to Accountable Health Network plans. These Plans require you to partner with a specific medical group and obtain your medical services there. The ability to go outside the Medical Group is fairly limited and does require a referral and potentially an exception request.
Premera’s AHN’s – The Everett Clinic, EvergreenHealth Partners, MultiCare, NorthWest Physicians Network, UW and Virginia Mason
You are probably seeing this term pop-up more and more. It stands for “Exclusive Proivder Organization”. Which means that these type of plans don’t offer any out-of-network or out-of-area coverage. Carriers are moving to these to control costs. They still have fairly significant networks in the state - however, they only provide coverage for emergency services outside Washington.
I can’t afford health insurance. What now?
If you meet eligibility requirements, you may qualify for free or at deeply reduced premiums. Tax credits, expanded eligibility for Medicaid, and other subsidies will take effect in 2014, helping those in need afford coverage. Use this site to see what your estimated premium, deductibles and out-of-pocket costs will be before you enroll. There are a few ObamaCare alternative products out there as well – contact us for more information.
When is open enrollment?
The fifth open-enrollment period for buying insurance through an exchange begins on November 1 2017 and ends January 15 2018. Coverage purchased by Dec 15th 2017 will have a January 1 2018 effective date.
What if I already have coverage?
If you already have health insurance through your job, Medicaid, Medicare or another individual plan, any changes may be minimal. However, you may have access to additional benefits like preventative screenings, emergency services and prescription-medicine coverage. If you pay for your own coverage, you may qualify for new tax credits and financial assistance. You will also be able to insure adult children up to age 26.
Will I quality for a tax credit?
Individuals – $16,394 to $47,520 Couples – $22,107 to $64,080 Families of four – $33,534 to $97,200
Credits are based on a sliding scale, and are NOT available for those who are eligible for Medicaid, Medicare or who are eligible for coverage through an employer - recipients must be a US citizen or lawfully present, not incarcerated and reside in Washington.
What if I have questions that aren’t answered on the site?
Call us at 360–464–1622. We look forward to answering your questions and helping you choose the plan that’s best for you and your family.
Your Privacy is Important! We will not share your personal information with anyone outside of our organization except as required to secure your insurance coverage.
We will not sell or share your personal information with any third party and we will maintain the highest professional standards of confidentiality and integrity.
Washington Health Insurance Exchange is a division of the Washington Health
Insurance Agency whose agent/owner is a registered producer for
wahealthplanfinder.org and a licensed producer in the state of Washington.
Our staff and licensed agents are not government employees, employees of
the state, or the Washington Health Plan Finder. We make no claim or claims
to represent, constitute, and/or otherwise provide other services on behalf
of the Washington HealthPlanFinder. Any and all suggestions, claims, and/or
implications to the contrary are hereby denied.